CHAMPS: Choices for Adolescent Methods of Prevention in South Africa

描述(申请人提供)：在南非，年轻人的艾滋病毒感染率在普通人群中最高。青春期是一个复杂的过渡性发展阶段，与艾滋病毒感染有关的行为往往开始出现，目前或未来的任何艾滋病毒预防战略都可能需要年轻人有效地利用，才能在人口层面产生明显的影响。但是，尽管在年轻人中预防艾滋病毒的努力很重要，但在南非和其他资源有限的环境中，很少有干预措施在降低这一群体的艾滋病毒感染风险方面产生重大影响。该项目将通过一种新的方法来解决这一差距，将不同的艾滋病毒预防战略结合到针对青少年的优化预防“菜单”中，有艾滋病毒感染风险的年轻妇女和男子可以从中选择特定的战略组合，以满足他们的特定需求和情况。目前有一些前景看好且行之有效的预防干预措施，它们可能构成首选方案或组合的预防菜单，包括PrEP、杀微生物剂、艾滋病毒咨询和检测(HCT)和包皮环切术。在系统地审查了与这些和其他预防方法有关的文献之后，将设计试点研究，以审查与这些预防方法相关的青少年的可行性、可接受性、依从性和性行为改变等关键问题。研究将尽可能仿效服务和试验的实施，以解决这些问题，包括与实施和交付有关的伦理-法律问题，以及考虑向青少年传递信息和进行社会营销。结果将被用来为流行病学建模和成本计算工作提供信息，以便了解如何在年轻人中构建和推广这种预防‘菜单’，以最大限度地受益。这项研究将在另一项单独提出的试验中达到高潮，以检验“菜单”方法在预防南非青少年新的艾滋病毒感染方面的有效性。

DESCRIPTION (provided by applicant): In South Africa, young people have the highest incidence of HIV infection in the general population. Adolescence is a complex, transitional development phase when behaviors associated with HIV acquisition are often initiated, and it is likely that any current or future HIV prevention strategy will need to be effectively utilized by young people to have an appreciable population-level impact. But despite the importance of HIV prevention efforts among young people, there are few interventions that have demonstrated a significant impact in reducing risk of HIV infection among this group in South Africa and other resource-limited settings. This project will address this gap through a novel approach to combining different HIV prevention strategies into an optimized prevention 'menu' for adolescents, from which young women and men at risk of HIV infection may choose a particular combination of strategies to meet their specific needs and circumstances. Currently there are a number of promising and proven prevention interventions that could potentially constitute a prevention menu of preferred options or combinations, including PrEP, microbicides, HIV Counseling and Testing (HCT) and circumcision. After a systematic review of the literature relating to these and other prevention options, pilot studies will be designed in order to examine key issues of feasibility, acceptability, adherence and sexual behavior change associated with these prevention methods in adolescents. Studies will emulate implementation of services and trials as far as possible in order to address these questions, including ethico-legal issues associated with implementation and delivery, as well as consideration of messaging and social marketing of these approaches to adolescents. Results will be used to inform epidemiological modeling and costing exercises in order to inform how such a prevention 'menu' should be constructed and promoted among young people for maximum benefit. This research will culminate in a separately proposed trial to examine the efficacy of the 'menu' approach in preventing new HIV infections among South African adolescents.